Article in PDF
How to Cite
Citation Manager
Readers' Comments (0)
Audio Visual Article Statistics
Link
to PUBMED
Print this Article
Send to a Friend
Advertisers
Access Statistics Resources
Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Reviews
Full Version
Diagnostic Applications of Saliva
Correspondence Address :
Dr.Surabhi Yadav,Demostrator,House No -1- Couple HostelMedical Enclave,Pgims Rohtak Haryana (India)Pin- 124001,Email - surabhiyadavdr@gmail.com
Saliva is an easily accessible fluid that is rich in various proteins and enzymes. In addition to this, many drugs are also secreted in the saliva. It offers several advantages over blood as it is collected non-invasively and with much ease. In this article, the authors review various diagnostic applications of saliva.
Introduction
This review examines the diagnostic applications of saliva for systemic diseases. As a diagnostic fluid, saliva offers distinctive advantages over serum, because it can be collected non-invasively by individuals with modest training and fewer complications occur as compared to those seen during blood collection. Furthermore, saliva may provide a cost-effective approach for the screening of large populations. Whole saliva is most frequently used for the diagnosis of systemic diseases, since it can be readily collected and as it contains the same constituents as that of serum. These constituents are derived from the local vasculature of the salivary glands and also reach the oral cavity via the flow of the gingival fluid (Table/Fig 1).
Saliva has protective properties and contains a variety of antimicrobial constituents and growth factors. In addition, saliva has lubricating functions and aids in the digestion of food. The functions of saliva and the salivary constituents responsible for these functions are summarized in (Table/Fig 2).
Saliva can be collected either by a draining method in which saliva is allowed to drip off the lower lip or by the spitting method in which the subject spits saliva into a test tube (1).
Traditionally, saliva tests were used to detect hepatitis, tuberculosis or strep throat. Today, technology uses highly sensitive methods of detection that have turned saliva into a tool for the diagnosis of many conditions.
Analysis of saliva may be useful for the diagnosis of hereditary disorders, autoimmune diseases, malignant and infectious diseases, endocrine disorders, as well as for the assessment of the therapeutic levels of drugs and for the monitoring of illicit drug use.
Systemic Diseases (Hereditary, Autoimmune, Malignancy)
Hereditary Diseases
Cystic fibrosis (CF) is a genetically transmitted disease of children and young adults, which is considered as a generalized exocrinopathy. Elevated levels of calcium and proteins in submandibular saliva from CF patients were found and resulted in a calcium-protein aggregation which caused turbidity of saliva (2).The submandibular saliva of CF patients was also found to contain more lipid than the saliva of non-affected individuals and the levels of neutral lipids, phospholipids, and glycolipids were elevated (3). Elevations in electrolytes (sodium, chloride, calcium, and phosphorus), urea and uric acid and total protein were observed in the submandibuar saliva of CF patients (4).
21-Hydroxylase deficiency is an inherited disorder of steroidogenesis which leads to congenital adrenal hyperplasia. In non-classic 21-hydroxylase deficiency, a partial deficiency of the enzyme is present. Early morning salivary levels of 17-hydroxyprogesterone (17-OHP) were reported to be an excellent screening test for the diagnosis of non-classic 21-hydroxylase deficiency, since the salivary levels accurately reflected the serum levels of 17-OHP (5).
A saliva-based miniature system can provide a powerful platform for rapid DNA extraction and for the detection of genetic diseases. The mutated alpha-globin gene which is associated with alpha-thalassemia-1 can be detected in saliva by several critical modules, including a genomic DNA (gDNA) extraction module, a polymerase chain reaction (PCR) module and an external optical detection module, all within less than 1 hr (6).
Autoimmune Disease
Sjögren's syndrome (SS) is an autoimmune exocrinopathy of unknown aetiology. SS is characterized by the presence of a lymphocytic infiltrate (predominantly CD4+ T-cells) in the salivary gland parenchyma (7). A low flow rate and an abnormally low stimulated flow rate of whole saliva are also indicators of SS. Autoantibodies, especially of the IgA class, can be synthesized in salivary glands and can be detected in the saliva of SS patients prior to their detection in the serum. In addition to IgA, saliva has also been reported to contain IgG autoantiboiesd (8). SS anti-La antibodies were primarily found in the saliva of patients whose resting and stimulated whole saliva flow rates were abnormally low (9). The expression of human beta-defensins 1 and 2 are decreased in salivary glands which are affected by Sjögren's syndrome in comparison with the human beta-defensin expression patterns in the salivary glands from normal subjects (10).
Caeliac disease (CD) is a lifelong immune-mediated disorder which is caused by the ingestion of wheat gluten in genetically susceptible persons. Gluten stimulates naive lymphocytes directly in the oral cavity, which would have important implications for the understanding, diagnosis, and the management of CD by measuring CD-associated antibodies in saliva as a screening test (11).
Malignancy
A number of recent studies have focused on oncogenic marker detection and its monitoring in saliva. The latest clinical and laboratory findings on diagnostic markers of oropharyngeal carcinoma in oral fluid could be the beginning of their wider use as a diagnostic medium. Oral fluid can also be also used to diagnose other malignancies such as breast cancer, which was one of the first malignant tumours to be detected using genetic protein biomarkers (12).
Patients of head and neck carcinomas show reduced IgA levels in saliva but not in the serum. Causes associated with decreased salivary IgA levels like malnutrition, stress and tobacco could be related to these findings (13).
Salivary analysis may aid in the early detection of certain malignant tumours. P53 is a tumour suppressor protein which is produced in cells; p53 antibodies can also be detected in the saliva of patients who are diagnosed with oral squamous cell carcinoma (SCC) and can thus assist in the early detection of and screening for this tumour (14). Autoantibodies against p53 proteins (p53 abs) can be detected in the serum, ascites, saliva and pleural effusions of various cancer patients (15). Elevated levels of salivary defensin-1 were found to be indicative of the presence of oral SCC (16).
Elevated levels of recognized tumour markers c-erb-2 and cancer antigen 15-3 (CA15-3) were found in the saliva of women who were diagnosed with breast carcinoma, as compared to patients with benign lesions and healthy controls (17).
Elevated salivary levels of CA 125 were detected in patients with epithelial ovarian cancer. A positive correlation was found between salivary and serum levels of CA 125 (18).
A surface immobilized optical protein sensor has been utilized to detect Interleukin-8 (IL-8) protein, an oral cancer marker in saliva (19). Neutrophil levels in saliva may also indicate successful bone marrow transplant in haematological malignancies (20).
Drug Monitoring
As with other body fluids (i.e., serum, urine, and sweat), saliva has been proposed for the monitoring of the systemic levels of drugs (21). The pka of the drug (the ph at which 50% of the drug molecules are ionized) and the ph gradient between plasma and saliva determine the concentration gradient on both sides of the membrane and influence the availability of a drug in saliva (22). A significant correlation exists between salivary and serum lithium levels in patients receiving lithium therapy (23). Saliva is also useful for the monitoring of anti-epileptic drugs like cyclosporine, theophylline, digoxin, Quinine, etc. (24),(25),(26).
Saliva can be an alternative specimen for the therapeutic monitoring of cyclosporine (CsA) in children and patients with difficult venous access. For a highly protein-bound drug such as CsA, saliva may also provide a practical approach for measuring the unbound concentration (27).
The trans-3'-hydroxycotinine(3HC)/cotinine (COT)3HC/COT ratio derived from nicotine which has either been administered as a probe drug or from tobacco use which is measured in either plasma or saliva, is highly correlated with the oral clearance of nicotine. This ratio appears to be a useful noninvasive marker for the rate of nicotine metabolism (which is important in studying nicotine addiction and smoking behaviour), as well as a general marker for measuring CYP2A6 activity (which is important in studying drug and toxin metabolism) (28).
Drug Abuse/Recreational Drugs can also be monitored eg Amphetamines, Ethano (29).
Monitoring of Hormone Levels
Saliva can be analyzed as a part of the evaluation of endocrine function. Salivary cortisol levels were found to be useful in identifying patients with Cushing's syndrome and Addison's disease and also for monitoring the hormone response to physical exercise and the effect of acceleration stress (30). Evidence shows that salivary cortisol in evening samples or in those following dexamethasone suppression provides a reliable and effective screen for Cushing's syndrome (31). Measurement of an elevated late-night salivary cortisol has greater than 90% sensitivity and specificity for the diagnosis of endogenous Cushing’s syndrome. Late-night salivary cortisol measurements are also useful to monitor patients in remission and/or those having recurrence after pituitary surgery for Cushing’s disease. (32).
Salivary aldosterone levels demonstrated a high correlation with serum aldosterone levels (33). Increased aldosterone levels are found in both the serum and the saliva of patients with primary aldosteronism -Conn's syndrome. Measurement of aldosterone in saliva presents a useful and convenient method for application in multi-sampling studies (34).
Testosterone and dehydroepiandrosterone havealso been identified in saliva. Salivary testosterone levels are used for the assessment of testicular function (35). Monitoring salivary testosterone levels may also be useful in behavioural studies of aggression, depression, abuse and violent and antisocial behaviour (36).
It is well known that late-onset hypogonadism in males can cause a variety of symptoms and that the differential diagnosis is relatively difficult, including psychological disorders, stress, and mood disturbances. The levels of serum cortisol can be measured to reflect a patient's level of stress. Simultaneous measurement of testosterone and cortisol levels in saliva is done by liquid chromatography-tandem mass spectrometry (LC-MS/MS) (37).
Salivary estriol levels are used as a means for the assessment of foeto-placental function (38). Decreased salivary estriol was suggested as a marker for foetal growth retardation (39).
Salivary progesterone levels can be useful for the prediction of ovulation, demonstrating a correlation of 0.75 with serum progesterone levels and salivary oestradiol and progesterone levels can be used for the evaluation of ovarian function. An increased salivary estriol-to-progesterone ratio may be a predictor of pre-term delivery (40).
To study pineal function in newborn infants, saliva collection using cotton buds and the measurement of melatonin in saliva offers a valid, non-invasive, pain-free and practical alternative to blood sampling and for the determination of serum melatonin (41).
Diagnosis of Oral Disease with Relevance for Systemic Diseases
Saliva can be used for the detection of oral candidiasis and salivary fungal counts may reflect mucosal colonization. Saliva may also be used for the monitoring of oral bacteria (42). Bacteria (including anaerobic species) can survive in saliva and can utilize salivary constituents as growth media). Furthermore, increased numbers of Streptococcus mutans and Lactobacilli in saliva were associated with the prevalence and the presence of increased root caries (43). Saliva can serve as a vector for bacterial transmission and also as a reservoir for bacterial colonization. Detection of certain bacterial species in saliva can reflect their presence in dental plaque and in periodontal pockets (44).
The collection and analysis of Gingivalcrevicular fluid (GCF) are noninvasive methods which are used for the evaluation of host response in periodontal disease. These analyses mainly focus on inflammatory markers such as prostaglandin E2, neutrophil elastase and beta-glucuronidase and on the marker of cellular necrosis-aspartat aminotransferase. Further, the analysis of inflammatory markers in GCF may assist in defining how certain systemic diseases (e.g., diabetes mellitus) can modify periodontal disease and how peridontal disease can influence certain systemic disorders (atherosclerosis, preterm delivery, diabetes mellitus and some chronic respiratory diseases) (45).
Viral Diseases
Saliva was found to be a useful alternative to serum for the diagnosis of viral hepatitis. Acute hepatitis A (HAV) and hepatitis B (HBV) were diagnosed, based on the presence of IgM antibodies in saliva. Similarly, the analysis of saliva proved to be a highly sensitive and specific method for the diagnosis of viral hepatitis B and C. Saliva may also be used for determining immunization and also for detecting infections such as measles, mumps and rubella (46).
Antibody to HIV in whole saliva of infected individuals, which was detected by ELISA and Western blot assay, correlated with serum antibody levels (47).
Others
Rapid detection of Plasmodium falciparum histidine-rich protein II (PfHRP II ) antigen in saliva may be a useful non-invasive and cost-effective diagnostic technique for malaria (48).
Persons with periodontitis and type 2 diabetes have raised salivary Pro-calcitonin levels that reflect their degree of periodontitis activity and hyperglycaemia (49) . Salivary adiponectin may be used as a marker for the increased risk of non-insulin-dependent diabetes mellitus or for cardiovascular disease (50).
Saliva can be used as an alternative to serum as a biological fluid that can be analyzed for diagnostic purposes. Whole saliva contains locally produced as well as serum-derived markers that have been found to be useful in the diagnosis of a variety of systemic disorders. Whole saliva can be collected in a non-invasive manner by individuals with modest training, including patients. This facilitates the development and introduction of screening tests that can be performed by patients at home.
- Emerging Sources Citation Index (Web of Science, thomsonreuters)
- Index Copernicus ICV 2017: 134.54
- Academic Search Complete Database
- Directory of Open Access Journals (DOAJ)
- Embase
- EBSCOhost
- Google Scholar
- HINARI Access to Research in Health Programme
- Indian Science Abstracts (ISA)
- Journal seek Database
- Popline (reproductive health literature)
- www.omnimedicalsearch.com